January 22, 2018

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The White House is insisting that the Senate resume efforts to repeal and replace the nation's health care law, signaling that President Donald Trump stands ready to end required payments to insurers this week to let "Obamacare implode" and force congressional action.

"The president will not accept those who said it's, quote, 'Time to move on,'" White House adviser Kellyanne Conway said.

Those were the words used by Senate Majority Leader Mitch McConnell, R-Ky., after the stunning early Friday morning defeat of the GOP bill to repeal former President Barack Obama's signature legislative achievement. McConnell is already moving to other business, having scheduled Senate consideration later Monday on a judicial nomination.

Conway said Trump was deciding whether to act on his threat to end cost-sharing reduction payments, which are aimed at trimming out-of-pocket costs for lower-income people. "He's going to make that decision this week, and that's a decision that only he can make," Conway said.

Trump vented his frustration on Twitter Monday. He said: "If ObamaCare is hurting people, & it is, why shouldn't it hurt the insurance companies & why should Congress not be paying what public pays?"

In fact, most members of Congress get their coverage through the Affordable Care Act like millions of other Americans. The 2010 law was specifically written to include lawmakers, and starting in 2014, members and their staffs had to use federal or state health care exchanges.

Most members who use the coverage buy it off the health care exchange created by the District of Columbia.

For seven years, Republicans have promised that once they took power, they would scrap Obama's overhaul and pass a replacement. But that effort crashed most recently in the Senate on Friday.

Republicans hold a 52-48 majority in the Senate, where no Democrats voted for the GOP bill and three Republicans defected in the final vote Friday. One of the GOP defectors, Sen. John McCain, has since returned to Arizona for treatment for brain cancer.

"Don't give up Republican senators, the World is watching: Repeal & Replace," Trump said in a tweet.

White House budget director Mick Mulvaney, when asked Sunday if no other legislative business should be taken up until the Senate acts again on health care, responded "yes."

While the House has begun a five-week recess, the Senate is scheduled to work two more weeks before a summer break. McConnell has said the unfinished business includes addressing a backlog of executive and judicial nominations, coming ahead of a busy agenda in September that involves passing a defense spending bill and raising the government's borrowing limit.

"In the White House's view, they can't move on in the Senate," Mulvaney said, referring to health legislation. "They need to stay, they need to work, they need to pass something."

Trump warned over the weekend that he would end federal subsidies for health care insurance for Congress and the rest of the country if the Senate didn't act soon. He was referring in part to a federal contribution for lawmakers and their staffs, who were moved onto Obamacare insurance exchanges as part of the 2010 law.

"If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!" Trump tweeted.

The subsidies, totaling about $7 billion a year, help reduce deductibles and copayments for consumers with modest incomes. The Obama administration used its rule-making authority to set direct payments to insurers to help offset these costs. Trump inherited the payment structure, but he also has the power to end them.

The payments are the subject of a lawsuit brought by House Republicans over whether the health law specifically included a congressional appropriation for the money, as required under the Constitution. Trump has only guaranteed the payments through July, which ends Monday.

Sen. Susan Collins of Maine, one of the three Republican senators who voted against the GOP health bill on Friday, said she's troubled by Trump's claims that the insurance payments are a "bailout." She said Trump's threat to cut off payments would not change her opposition to the GOP health bill and stressed the cost-sharing reduction payments were critical to make insurance more affordable for low-income people.

"The uncertainty about whether that subsidy is going to continue from month to month is clearly contributing to the destabilization of the insurance markets, and that's one thing that Congress needs to end," said Collins, who wants lawmakers to appropriate money for the payments.

"I certainly hope the administration does not do anything in the meantime to hasten that collapse," she added.

Trump previously said the law that he and others call "Obamacare" would collapse immediately whenever those payments stop. He has indicated a desire to halt the subsidies but so far has allowed them to continue on a month-to-month basis.

Conway spoke on "Fox News Sunday," Mulvaney appeared on CNN's "State of the Union" and Collins was on CNN as well as NBC's "Meet the Press."

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